E-ISSN 2587-0610
Laparoscopic Endoscopic Surgical Science (LESS) - Laparosc Endosc Surg Sci : 24 (2)
Volume: 24  Issue: 2 - 2017
1.The effects of pneumoperitoneum pressure on blood gases, respiratory and venous systems during laparoscopic cholecystectomy: A prospective randomized trial
Nihat Aksakal, Korhan Taviloğlu, Hakan Teoman Yanar, Simru Tuğrul, Adem Uçar, Mustafa Tükenmez, Ali Fuat Kaan Gök, Fatih Yanar
doi: 10.14744/less.2017.25744  Pages 31 - 37
INTRODUCTION: Increased abdominal pressure during pneumoperitoneum may distress respiratory functions and venous systems. The aim of this study was to evaluate the effect of low and high pneumoperitoneum pressure during laparoscopic cholecystectomy.
METHODS: Total of 40 patients were randomized for use of either low (8 mmHg) or high (14 mmHg) pneumoperitoneum pressure. Respiratory mechanics were monitored continuously, arterial blood gases were analyzed via radial artery catheter, and duplex scan of left common femoral vein was performed. Ten days after surgery, venous duplex scan of lower limbs was used to detect signs of deep vein thrombosis.
RESULTS: While peak inspiratory pressure significantly increased with low and high pneumoperitoneum pressure, dynamic compliance significantly decreased. Although carbon dioxide insufflation caused decrease in blood pH in both groups, it was only significant at high pneumoperitoneum pressure. Duplex scan of femoral vein revealed significant increase in diameter and decrease in peak blood velocity at high pneumoperitoneum pressure.
DISCUSSION AND CONCLUSION: Respiratory acidosis may occur due to decreased compliance, and pneumoperitoneum causes reversible venous stasis, especially during use of high pressure. Results indicated that performing laparoscopy with lower pneumoperitoneum pressure decreased these adverse effects, especially in patients with cardiopulmonary comorbid diseases. Prophylaxis for venous thromboembolism in high-risk patients undergoing laparoscopic cholecystectomy is recommended.

2.Laparoscopic partial and total splenectomy in non-trauma patients
Selman Uranüs
doi: 10.14744/less.2017.66376  Pages 38 - 45
INTRODUCTION: Developments in equipment and refinements in surgical technique have made minimally invasive surgery possible on parenchymatous organs, including the spleen. Due to the organ’s important immunological functions, organ conservation has high priority in spleen surgery, and this must be taken into consideration in laparoscopic surgery.
METHODS: For laparoscopic splenectomy and hemisplenectomy in non-trauma cases, 3 to 4 trocars are used with the patient in semilateral recumbent position. Ultrasonic scissors or Ligasure (Covidien-Medtronic, Inc., Minneapolis, MN, USA) instrument is used to dissect the vessels and mobilize the spleen. The vessels are carefully prepared and, for hemisplenectomy, dissected selectively. For splenectomy, an endostapler with a vascular cartridge is usually used to sever the hilar vessels. For partial resection, the parenchyma is also separated with same instrument. In the present study, 156 patients in a period of 14 years were operated on using this technique: There were 23 resections of the lower pole, 39 of the upper pole, 5 subtotal resections, and 89 splenectomies.
RESULTS: Laparoscopic splenectomy or hemisplenectomy was successfully completed in 152 of 156 patients. Four patients had to be converted to open technique due to intraoperative bleeding. No patient required reoperation and hospital mortality was 0. In every case of diagnostic partial resection of the spleen, it was possible to establish firm diagnosis.
DISCUSSION AND CONCLUSION: Laparoscopic operation on spleen with long axis of up to 24 cm is expedient and practicable. For spleen of normal or slightly enlarged size, laparoscopy can even be seen as the standard procedure for splenectomy. Patients with hematological disorders have greater surgical risk due to the comorbidity; it is they who receive the greatest benefit from this approach.

3.Does propofol sedation increase the cecal intubation rate in colonoscopy?
Ali Tardu, Zeliha Türkyılmaz, Makbule Elif Yılmaz, Gürhan Çelik
doi: 10.14744/less.2017.64936  Pages 46 - 49
GİRİŞ ve AMAÇ: Kolonoskopi prosedüründe en önemli kalite göstergelerinden biri çekumun entübe edilmesidir. Bu çalışmada propofol sedasyonunun çekum entubasyonu üzerine etkisini irdelemeyi amaçladık.
YÖNTEM ve GEREÇLER: Propofol tabanlı sedasyonla kolonoskopi işlemi yapılmış toplam 186 hasta retrospektif olarak incelendi. Yedi olgu çeşitli nedenlerle çalışma dışına alındı. Hastaların demografik verileri, kolonoskopi bulguları ve sedasyon protokolü kaydedildi.
BULGULAR: Toplam 179 hastanın 100’ü erkekti. Hastaların ortalama yaşı 54.8±16.2, Body mass index ortalaması ise 26.6±3.6 idi. Uygulanan propofol dozu ortalama 141.5±49.1 mg idi. Hastaların 176’sında (%98.3) çekum entübe edilmiştir. Hiçbir hastada kolonoskopiye ait majör bir komplikasyon gelişmedi.
TARTIŞMA ve SONUÇ: Çalışmamızdaki çekal entubasyon oranının literatürdeki verilere kıyasla yüksekliği ve hastalarda herhangi bir komplikasyon yaşanmamış olması propofol esaslı sedasyonun hem güvenilir hem de etkin olduğunu düşündürmektedir.
INTRODUCTION: One of the most important quality indicators in a colonoscopy procedure is intubation of the cecum. The aim of this study was to investigate the effect of propofol sedation on cecal intubation.
METHODS: A total of 186 patients who underwent colonoscopy with propofol-based sedation were examined retrospectively. Seven cases were excluded from the study for various reasons. Patient demographic data, colonoscopy findings, and sedation protocols were recorded.
RESULTS: Of the 179 patients included, 100 were males. The mean age was 54.8±16.2 years, and the mean body mass index was 26.6±3.6. The average propofol dose was 141.5±49.1 mg. The cecum was intubated in 176 cases (98.3%). None of the patients were observed to develop a major complication as a result of the colonoscopy.
DISCUSSION AND CONCLUSION: In the current study, both the cecal intubation rate, which is higher than what is suggested in the related body of literature, and the fact that no complications were observed in any of the patients could suggest that propofol-based sedation is both safe and effective.

4.Splenic abscess secondary to sleeve gastrectomy leak
Hiba Shanti, Firas Obeidat
doi: 10.14744/less.2017.47955  Pages 50 - 53
Sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. A 34-year-old male patient with body mass index of 69.9 was admitted to hospital 4 months after sleeve gastrectomy with epigastric pain and fever, and leak at the gastroesophageal junction was observed on computed tomography scan. In addition, he had splenic vein thrombosis with infected partial splenic infarction with abscess formation. Endoscopic stent was used to cover the leak and percutaneous drainage of the splenic abscess was performed. Partial infarction of the spleen is not a rare occurrence after laparoscopic sleeve gastrectomy. However, abscess development is extremely rare. Familiarity with these rare complications will allow for prompt diagnosis and treatment.

5.Totally laparoscopic pancreaticoduodenectomy with tangential portal vein resection
Igor E Khatkov, R E Izrailov, P S Tiutiunnik, Ahmet A Khisamov
doi: 10.14744/less.2017.36844  Pages 54 - 57
Totally laparoscopic pancreaticoduodenectomy (TLP) is an oncologically safe and feasible technique. It is performed in centers experienced in laparoscopic hepatobiliary surgery. Locally advanced pancreatic cancer with portal venous invasion seems to be a relative contraindication for laparoscopic surgery. There is no definitive data supporting such an approach. Case of a 47-year-old male patient with locally advanced pancreatic cancer determined to have portal confluence invasion in the preoperative period is reported in this study. Tumor was successfully resected with laparoscopic tangential portal vein resection (TPVR). In a selected patient with locally advanced pancreatic cancer, TLP with TPVR appears to be a safe and viable procedure when performed in high-volume centers with experience in laparoscopic hepatobiliary surgery.

6.A comparison of the outcomes revision of the Roux-en-Y and Mini-Gastric Bypass: hard vs. easy
Robert Rutledge, K. S. Kular, Naveen Manchanda, Mohit Bhandari, Rajat Goel
doi: 10.14744/less.2017.69188  Pages 58 - 62
The Mini-Gastric Bypass (MGB) is growing in popularity. Roux-en-Y gastric bypass (RNY) is one of the most common forms of bariatric surgery. The purpose of this paper was to review some of the recent research reporting outcomes of RNY and MGB and to compare the reported results with special attention to leak and complication rates after revision of MGB and RNY. Although there are reports of RNY with good outcomes, many reports document RNY to be a technically difficult procedure with reported complication rates as high as 10% to 30%. In review of recent papers, revision of RNY was associated with roughly double the rate of leaks and complications compared with primary RNY: 20% to 40%. RNY is one of the most commonly performed forms of bariatric surgery. Primary RNY and RNY revision are technically challenging, with moderately high reported leak and complication rates. Numerous studies of MGB have reported the operation to be straightforward with low risk of complications, leak, or bile reflux. Reports of complications or leak after MGB revision are also quite low, and revision is reported to be “easily done.”

7.Revisional bariatric surgery: An update
Isabelle Debergh, Bruno Dillemans
doi: 10.14744/less.2017.69885  Pages 63 - 66
Obesity can be defined as a chronic disease with a serious impact on an individual’s quality of life; moreover, it is a leading risk factor for global death. Bariatric surgery has already proven its efficacy in providing the patient with a healthier life. Nonetheless, failure of initiated treatment can occur in medical practice. We can and should offer our patients correct, patient-tailored revisional therapy conducted by an experienced surgeon in a high-volume hospital facility. In this article, current indications and strategies for secondary bariatric procedures were summarized.

8.Abdominal effects of laparoscopic surgery
Hüseyin Kerem Tolan, Fikret Ezberci
doi: 10.14744/less.2017.53824  Pages 67 - 73
Pnömoperiton (PNP) laparoskopik cerrahinin saha çok kullanılması ile yaygın olarak uygulanmaktadır. Minimal invazif cerrahiye de tüm cerrahi yöntemlerde gittikçe artan bir yönelim bulunmaktadır. Hasta üzerinde daha az sistemik ve lokal etkilere neden olduğu düşünülmektedir. PNP esnasında intraperitoneal basınç (IPP) batın içinin daha iyi görülmesi için normal batın içi basınçtan çok daha yukarılara çıkartılmaktadır. Bu işlemlerin süresi de açık cerrahiden daha zor olması ve daha kompleks olmaları nedeniyle çok daha uzun sürebilmektedir. Abdominal kompartman sendromunda da görülebildiği gibi bu yüksek IPP hastaların fizyolojileri üzerinde yan etkilere neden olabilmektedir.
Pneumoperitoneum (PNP) is very commonly performed in surgical practice due to the extensive use of laparoscopic surgery. In minimally invasive surgery, there is an effort to convert all eligible surgical procedures to a laparoscopic technique, as it has fewer systemic and local surgical effects on the patient. During PNP, intraperitoneal pressure (IPP) is increased to well above normal intra-abdominal pressure in order to create an opening for visualization of the abdominal contents. The duration of these procedures can be prolonged as a result of the difficulties and complexities of these techniques. IPP has side effects on the physiology of patients, as is seen in abdominal compartment syndrome.

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